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Medicine

Ohio heart transplants decline as organs go to other states

View SlideshowRequest to buy this photoEamon Queeney | DISPATCH photosA patient's new heart is reflected in Dr. Bryan Whitson’s glasses as his team performs a heart transplant at Ohio State University’s Ross Heart Hospital. OSU’s Comprehensive Transplant Center performed 10 heart transplants last year, about half of its peak of 19 in 2006.

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The number of heart transplants performed in Ohio dipped last year to its lowest level since
1989, but not because the waiting list is becoming shorter.

In fact, of the 155 people who were waiting for heart transplants in Ohio as of Feb. 7, 59
percent had been doing so for at least a year, according to a
Dispatch analysis of Organ Procurement and Transplantation Network data. That’s the
highest rate in the nation.

The Cleveland Clinic, which performed about two-thirds of the state’s heart transplants last
year, has seen its transplantation numbers decline in the past seven years by more than 40 percent,
from 76 to 44.

Ohio State University’s Comprehensive Transplant Center performed 10 heart transplants last
year, about half of its peak of 19 in 2006. So far this year, it has performed two.

The decline is worrisome, said Dr. Nader Moazami, the surgical director of cardiac
transplantation and mechanical circulatory support at the Cleveland Clinic.

He shared one recent example in which a heart donated in Columbus went to an out-of-state
patient instead of to one in Cleveland. Before 2006, that heart would have stayed in Ohio, he said.
Now, hearts can be sent as far as 500 miles away.

As a result, Ohio has become a net exporter of donor hearts since 2006, with the number of
hearts leaving the state exceeding the number entering the state by more than 70 over the past
seven years.

From 1991 to 2006, the state was a net importer, with the number of heart transplants exceeding
the supply of hearts originating in Ohio by 460, or by 29 percent.

The allocation policy change in 2006 achieved its goal. Research published in 2012 in the
journal
Circulation: Heart Failure found that, since the policy took effect, the risk of death on
the waiting list or of patients becoming too sick for transplant had decreased by 17 percent
nationwide.

But the Cleveland Clinic saw a 16 percent decline in heart transplants during the subsequent
year, and the number of transplants has fallen almost every year since. Meanwhile, in the past five
years or so, the average waiting time for a heart at the clinic has climbed from three months to
more than nine months.

That’s somewhat of a positive sign — transplant candidates are living longer. But it also shows
that donor hearts have become a scarcer resource in Ohio.

A spokesman said Ohio State currently has a median waiting time of seven months for a heart
transplant, above the national median of 5.6 months. The spokesman said waiting times have
increased “somewhat” and attributed the longer times to lower rates of organ donation in recent
years.

Surgeons at the Cleveland Clinic suspect that one reason for the decline in heart transplants
involves the use of left-ventricular assist devices, or LVADs, which are implanted mechanical pumps
that support function and blood flow in people with weakened hearts.

The devices help keep patients alive while they wait for a heart transplant.

Years ago, complication risks from LVADs were higher, and many patients receiving one were given
priority status for heart transplants.

That priority status has benefited regions of the country where a higher proportion of
transplant candidates have had LVADs implanted, including parts of the East Coast within 500 miles
of Ohio transplant centers, said Dr. Randall Starling, the Cleveland Clinic’s head of cardiac
transplant.

In the
Journal of Heart and Lung Transplantation, Moazami and other authors wrote that a dramatic
increase in transplant candidates who have had LVADs implanted suggests that the United Network for
Organ Sharing needs to update its policy.

“Our system inappropriately offers advantages to some and discriminates against other patients,”
the article states. “The time has come to re-evaluate the urgency status of uncomplicated LVAD
patients.”

Dr. Joseph Rogers, vice chairman of the United Network for Organ Sharing’s thoracic committee,
said the committee is aware that some regional disparities in the system need to be addressed.

However, the notion that a heart should remain in the state where it is donated is antiquated,
said Dorrie Dils, the chief clinical executive for Lifeline of Ohio, which is the organ-procurement
agency that serves 37 counties in central and southeastern Ohio. Organs are now seen as a national
resource “rather than belonging in the state where the patient died,” she said.

Donors “just want to help someone,” whether that person lives in the same state or not, Dils
said.

Heart transplants were on pace last year to increase slightly nationwide and set an annual
record by topping 2,500, based on data for the first 11 months of the year.

In some ways, technology promises to overhaul the organ-donation process, said Rogers, who is
also medical director of the cardiac transplant and mechanical circulatory support program at Duke
University.

For example, the current recommendation is that hearts should be transplanted within four hours
of donation, limiting how far the hearts can travel, he said. Researchers are working to increase
the time that hearts and other organs can be outside the body, he said.

But Rogers said that total artificial-heart technology is likely years away from being a
legitimate alternative to transplantation.

Dr. Robert Higgins, who heads the heart-transplant program at OSU’s Wexner Medical Center, said
such artificial hearts remain a good fit for only a small percentage of the population. Ohio State
implanted its first total artificial heart in 2006 but hasn’t done one since.

“It’s an expensive proposition,” Higgins said of the effort to develop an artificial heart. “A
number of companies have gone out of business trying to negotiate Food and Drug Administration and
regulatory hurdles.”